MSK Special Tests: WRIST/HAND

Question 1

Eichoff/Finkelstein’s

Answer 1

Finkelstein: ID DeQuervain tenosynovitis (paratendonitis of ABDUCTOR POLLICIS LONGUS and/or EXTENSOR POLLICIS BREVIS)
Eichoff: thumb inside fist
(+) pain with ulnar deviation

Question 2

Bunnel-Littler Test

Answer 2

IDs joint or intrinsic tightness of PIP joints
-MCP stabilized in slight extension, PIP flexed
-MCP flexed with PIP flexion
-Differentiates between tight capsule and tight intrinsics
Flexion limited in both = capsule
More PIP flexion with MCP flexion = intrinsics

Question 3

Tight retinacular test

Answer 3

IDs tight PIP
-PIP stabilized in neutral, DIP flexed
-PIP flexion and DIP flexion
—Differentiates tight capsule vs tight retinacular ligaments
Flexion limited both ways = capsule
Increased flexion DIP with PIP flexed = tight retinacular ligament

Question 4

Ligamentous Instability

Answer 4

Med/lateral IDs laxity or restriction
Support/stabilize fingers, apply varus/valgus force to joints
(+) laxity

Question 5

Froment’s

Answer 5

ID Ulnar N dysfunction (adductor pollicis)

-Grasp paper between 1st and 2nd digits, pull paper out and look for thumb flexion = compensation for add poll weakness

Question 6

Tinel’s

Answer 6

Tap over carpal tunnel

(+) median nerve compression

Question 7

Phalen’s

Answer 7

CTS - median N

Maximally flex wrists, holding against each other 1 minute

Question 8

2 pt discrimination

Answer 8

IDs level of sensory innervation w/in hand that correlates with functional ability to perform certain tasks involving grasp

• 2 pt simultaneous to palmar aspect- record smallest distance
• NORMAL = <6 mm discrimination btwn 2 pts

Question 9

Allen Test

Answer 9

ID vascular compromise
-compress radial and lateral arteries at wrist, pt opens/closes fist quickly several times then closes fist
-pt opens palm as release one artery, look for vascular filling
(+) abnormal filling of blood in hand during test
Normal = white —> filling

Question 10

Flick test

Answer 10

ID CTS
Move hand like shaking thermometer (active)
(+) CTS symptoms

Question 11

Murphy

Answer 11

Make fist

(+) 3rd met stays in line with 2nd and 4th indicates LUNATE dislocation

Question 12

Watson

Answer 12

Scaphoid shift test
Pronation, ulnar deviation, slight extension —> radial deviation
(+) clunk/pain indicates carpal instability